OPINION

'Halt the jokes. The assault on nursing needs a serious response'

3 May, 2011 | By Mark Radcliffe

The defining condition of nursing since I came into it more than 25 years ago has been this: nurses are held responsible for the care and wellbeing of patients but hold no responsibility for the politics, circumstances or organisation in which the care takes place

Against a backdrop of more modernisations than Madonna, nursing is required to stay solid - preferably docile - and deliver care, maintain standards and leave the politics and organisation of the health services they work in to the boys.

It is a mentality born of the last century and the one before that. Nursing was a vocation populated by strong, sometimes wise and usually servile women who eschewed things like money or a life in order to care unendingly.

Of course, such numbed dedication eventually became outdated and was replaced slowly by something more modern, slightly more thrusting and certainly more articulate. Professionalism, whatever that means, brought different expectations, wider responsibilities and a more sophisticated self-consciousness.
It did not, however, bring any political clout or will. Away from the bedside, nursing did not shape the political landscape, satisfying itself instead with a few crumbs from the table in the form of a seat on the board and a civil service post with the word “nurse” in the title.

There is something almost dignifying about that abstention. We have watched endless reorganisations and known it is a nurse’s responsibility to find a way of providing care in spite of the politicians; more often than not, nurses have managed to do that. We have watched new organisations, new economic relationships, new management structures and new ways of measuring services turn into mini-industries and mostly shrugged and got on with it, albeit at some cost.

But now it feels slightly different, doesn’t it? Now the political assault is not only on services but also on nurses themselves. Recruitment freezes? Pay freezes? And, in return for not making redundancies, an increment freeze? Was there even a pause between “frontline services will not be at risk” and “if you want to avoid redundancies, agree not to take your incremental pay rise”?

Most nurses are not remotely surprised but anticipating an assault is not a response. The response begins now and the question is: is nursing equipped to make it an effective one? How many times have we heard that “nurses are angry”? Angry with the government, the health secretary, bankers, insurance salesmen, each other, Wayne Rooney, themselves…. So angry they find a way of running a ward with no staff, working 15 unpaid extra hours a week and making themselves close to ill in the process, but stamping their feet occasionally while they do it and looking very cross for two or three days at a time.

Frankly, if nursing does not find an appropriate, powerful and intelligent response to this assault, it will remain a political adolescent - full of emotion but without the capacity to turn that emotion into something formidable. This is not about tired and divisive “should we strike or not?” debates - politicians are banking on arguments like that splitting a workforce as big and as malleable as nursing. It is about creative, considered and effective responses to protect not only nursing but also the interests it serves; patient wellbeing, standards of practice and a progressive, civilising society that values care.

For that to happen, nursing will have to act. The question is: does its leadership have the will or the ideas to act effectively?

Readers' comments (55)

Anonymous | 3-May-2011 11:09 am
Fantastically well put Mark!
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Peedoffnurse | 5-May-2011 9:47 am
I would not dismiss the strike debate as it is burning within many at the moment but agree it is not the ideal answer. As an ex miner I think it would no doubt become a bit of a "miners versus Maggie" situation and the workforce may suffer a split from which we may never recover. I agree with your sentiments but feel you do not put forward a viable alternative solution.
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Anonymous | 5-May-2011 3:19 pm
I think we need to get creative with our response. We could create a new, usable and quick paperwork or stop answering the phones or chasing everybody elses' mistakes maybe??
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Adrian Bolt | 5-May-2011 8:35 pm
“Nursing was a vocation populated by strong, sometimes wise and usually servile women”

Servile??? You would not have dared say that to the retired senior nurse, now sadly deceased, who used to live next door to my parents. She would have had your bollocks for a necktie. And what is wrong with having a vocation?? Can’t say I have ever had one myself but it sounds rather nice.

“such…….dedication eventually became outdated and was replaced …by something…., slightly more thrusting”

Sad but true. “Something slightly more thrusting?” Oh please I know in the days of my parents neighbor the nursing profession was predominately female but some of those women had more bollocks than all of the current flock of phyto-oestrogen induced girly men that inhabit the higher echelons’ of the RCN put together

“And, in return for not making redundancies, an increment freeze?”

Can anyone name me any other industry that awards its work force an incremental pay rise regardless of talent or ability? An increment awarded in addition to any nationally negotiated pay rise to take into account any increase in the cost of living (With the possible exception of the railways that is)

So angry they ………work.... 15 unpaid extra hours a week

Is this another reference to that RCN congress survey of 100,000 nurses of whom only 2000 bothered to reply? In which case no valid conclusion can be drawn from a sample size that is that laughably small, And the “whopping 95%” (of the 2000) who said they did work extra hours, well does the term “sampling bias” or self selection bias” mean anything to you?
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debsmth9@hotmail.com | 6-May-2011 12:31 pm
I wander if there are any plans to actually put people from the frontline of nursing on this panel. I would give that Mr Cameron 'a not now dear'!! Considering he was not my choice for PM. I have been in nursing for over 20yrs and I have seen a lot of changes, not all bad but there is always room for improvement. I didn't want to be a nurse for the money or just because it was a job. For me it's a vocation. Patient care should always come first. When it comes to making decisions on patient care or NHS reforms people from the very frontline should be consulted, but they never are.
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Andrew Fishburn | 6-May-2011 2:29 pm
Edwin Harnell - I love it when someone doesn't let the facts get in the way of a good argument! Have you looked in a health care establishment lately? Female nurses still outnumber the blokes significantly.

There are two Gateways on every band within the AFC pay structure; those without the talent or ability don't get the next increment. If you you use a search engine (Google is rather good), these and other facts concerning nursing and AHP pay can be easily accessed. All at the touch of a button. Super!

Mark - you are absoloutely right; the leadership need to articulate clear, legal advice that keeps us within the code (Edwin, that's our professional Code of Conduct: lots of info and facts at the NMC website which you can access at the touch of a button), but is effective. Undoubtedly there is a growing appetite for strike action and this, coupled with that effective leadership which you mention (which is currently absent) has the potential to bring results.

Great piece - keep them coming.
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Adrian Bolt | 6-May-2011 5:49 pm
@ Andy

“Female nurses still outnumber the blokes significantly”

I would not disagree with you.......and your point is?

“There are two Gateways on every band within the AFC pay structure; those without the talent or ability don't get the next increment.”

So you say, but even if that is the case (and personally I doubt it) they will get their regular increments between gateways.

Nevertheless can you name for me another industry that awards its work force an incremental pay rise regardless of talent or ability? No I thought not.

“Edwin, that's our professional Code of Conduct: lots of info and facts at the NMC website which you can access at the touch of a button”

Again your point is?..............on second thoughts don’t bother why let good rhetoric get in the way of a good argument.
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mark radcliffe | 6-May-2011 10:39 pm
Andrew M: I certainly wouldn't dismiss the idea of striking either, I would simply be cautious about only having predictable strategies available.
Edwyn: re your 'sample size' preoccupation, you do realise you are making the same point I did right?
Andrew F: thank you and good point re clarity around the C of C. Do you not wonder if maybe, given the last 10 years or so of Nursing's preoccupation with 'leadership' we may not find out what that idea amounts to?
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Andrew Fishburn | 7-May-2011 11:05 am
Edwin: your comment mentioned that in the days of your parents' neighbour being female dominated as though it was important to your point. I'm not sure if you are a nurse, but as Mark alluded, modern nursing is still seen as a profession that is easy to control and subservient to political masters and this is an inheritance from our past.

You are right that nurses can move from increment to increment between gateways, but, there is a annual performance review mechanism in place that supports this progression. If a nurse is clearly not practising at the required level at the annual appraisal then fitness to practice issues are raised and if necessary removed from practice. Increments reflect experience, expertise and education within a pay band. It is common practice in industry to reward employees for additional skills and qualifications but the current pay structure in nursing doesn't do this -it reflects your job role.

Teachers, police, doctors, allied health professionals, and fire fighters all have incremental pay systems. I can't say if their system rewards them regardless of talent or ability.

Mark: I believe that there is an opportunity here for the profession to show some leadership and that means developing political leadership not merely professional leadership. I feel very uncertain about our ability to do this. The next year has the potential to define what nursing leadership really is - I hope we don't miss the boat and then have a moaning fest!
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Andrew Fishburn | 7-May-2011 11:23 am
Increments reflect experience, expertise and education within a pay band. It is common practice in industry to reward employees for additional skills and qualifications but the current pay structure in nursing doesn't do this -it reflects your job role.

Is meant to read "Increments are meant to reflect..."
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Anonymous | 7-May-2011 6:42 pm
The current Government is attacking all Public service workers. here is a radical idea why are we not all acting together to stop this attack? Or at the very least all NHS staff should be coordinating action, my husband is a consultant and has had a pay freeze the last two years and faces the same for the next two, thats four years with no rise (there are no more increments on his pay scale). He faces an almost daily increase in agression and hostility from management in our Trust as they seem to have very different agendas, I have never known him to be so miserable at work.
So it's not just nurses you see, we all need to support each other.
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Adrian Bolt | 7-May-2011 8:59 pm

@Mark
Edwyn: re your 'sample size' preoccupation, you do realise you are making the same point I did right?

Er no not really. Interesting you see my interest with statistical validity as a “preoccupation” I would have thought you would have agreed that was a good thing. Accuracy, evidence based and all that. No?

@Andy
“Edwin: your comment mentioned that in the days of your parents' neighbour being female dominated as though it was important to your point.”

My point was that despite being a female dominated profession (as it still is) the women who made up the profession in the days of my parents neighbour were anything but servile. I was also taking issue with the notion of dedication and nursing being a vocation that the current brand of nurses (including Mark Radcliffe) appear to think is a dirty word now. I say again, what is wrong with having a “vocation” for nursing not that I have ever had one myself you understand. Why is professionalism and vocation incompatible?

“Increments reflect experience, expertise and education within a pay band.”

Well in theory perhaps but in practice I think not. In my experience the only skill needed to get ones annual increment is to be upright, warm and in possession of a pulse, and the only qualification is to be actually employed by the trust and not to have actually killed anyone.

BTW what are these “gateways” of which you speak? I don’t remember passing through any gateways on my steady and predictable progression to the top of my current pay scale. Perhaps they had all been left open by my predecessor and I didn’t notice.

I notice all your examples of professions having incremental pay rises are taken from public service. Care to mention any private industries that operate a similar system? No I thought not. And BTW yes I am a nurse for my sins.

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Anonymous | 7-May-2011 10:38 pm
Female dominated profession or not, we still sound like a load of old women.

Personally, as a ward manager I believe the time has come to take strike action.

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Anonymous | 7-May-2011 10:42 pm
In addition to the above, I personally would not allow progression through gateways unless sufficient learning / evidence was provided.

I would also ensure my ward was safely staffed while strike action took place.
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Anonymous | 7-May-2011 11:11 pm
Anonymous 7-May-2011 10:38pm and 10:42pm

Well said! As someone in the same professional position, I couldn't agree more
with your sentiments. Let's stop the rhetoric and point scoring and take some decisive action.
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Adrian Bolt | 8-May-2011 10:06 am
@ Anon 07/05/11 10:42hrs

"I would also ensure my ward was safely staffed while strike action took place."

And who would that inconvenience exactly?
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Allison Hamilton | 8-May-2011 10:22 am
Mark, as usual a thought-provoking article.

Edwin Harnell | 7-May-2011 8:59 pm:

As a midwife, I have an annual performance review and an annual review with my named supervisor of midwives. I have to demonstrate how I have developed in the past year and how I intend to continue developing in the next. Every year since I qualified I have not failed to earn the increment that is given to reflect experience. Every year it gets harder because the Trusts can no longer afford to send staff on training courses so applications have to be made for charitable funds (a long and arduous process) or you fund them yourself. It has also been agreed that I am ready to pass through the next gateway but jobs in the next band are few and far between because they have all been downgraded. I am now doing the job of someone a band higher without the recognition or the financial incentive.

If I come in 5 minutes late, everybody notices but if I leave 2 hours late nobody bats an eyelid. We are permanently short-staffed. We work with minimal resources and most of us are absolutely exhausted by the end of every shift. But hey 'I am a professional and this is my vocation!'

And just for the record Edwin - the private sector might not get meagre incremental rises each year regardless of talent etc but have you not heard of the massive performance based bonuses they get at the end of each year. Bankers come to mind immediately but the same applies to my husband who works in another high profile private sector field - annual bonuses and incentives awarded depending on performance - these far outstrip our performance based annual increments!!!!

And something else for the record their cost of living increments are much higher than ours and tend to more accurately reflect inflation especially now that ours is frozen at 0%!!!

Anonymous | 7-May-2011 6:42 pm

I can sympathise with your husband. I came into this profession full of excitement and enthusiasm but 8 years down the line, I have never felt so miserable at work.
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Anonymous | 8-May-2011 10:56 am
in short we need to get rid of all this general management nonsense which stems from american industry and find more suitable ways to manage the healthcare professions so that those working on front line services can get on with the work they have been trained to do with adequate renumeration without being hampered by meaningless management strategies which are detrimental to patient care which one would normally assume is central to the purposes of the organisation.
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Anonymous | 8-May-2011 1:07 pm
Edwin Hartnell 8-May-2011 @10:06am

The author of the post you challenged stated:
"I would also ensure my ward was safely staffed while strike action took place."

Your reply:
"And who would that inconvenience exactly?", worries me somewhat.

There is a huge difference between causing "inconvenience" and putting people in danger. A responsibly organised strike could cause considerable inconvenience in many areas of nursing, without putting patients in danger. The problem is, the question of whether or not nurses will reach consensus on appropriate and effective industrial action.
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Andrew Fishburn | 8-May-2011 9:01 pm
Edwin: "My point was that despite being a female dominated profession (as it still is) the women who made up the profession in the days of my parents neighbour were anything but servile." - Gotcha. But I disagree entirely - there was the odd nurse who wasn't serville (like the lass you mention) but in my opinion that very culture is why we still suffer the hangover of lack of leadership today.

"I say again, what is wrong with having a “vocation” for nursing not that I have ever had one myself you understand. Why is professionalism and vocation incompatible?" - They aren't. But it is understandable why there was a focus on professionalism. Just looking back through my old copy of 'Rituals, Research and Rational Actions' I'm horrified to see and remember how much of our practice was utter rubbish when I started (only 20 years ago) and there had to be a backlash against that kind of practice. But surely vocation, or calling to care, means that it is done to the highest professional standards possible?

"Well in theory perhaps but in practice I think not. In my experience the only skill needed to get ones annual increment is to be upright, warm and in possession of a pulse, and the only qualification is to be actually employed by the trust and not to have actually killed anyone. " ...suggests a complete lack of performance management from those in leadership roles.

"BTW what are these “gateways” of which you speak? I don’t remember passing through any gateways on my steady and predictable progression to the top of my current pay scale. Perhaps they had all been left open by my predecessor and I didn’t notice." There are two within each band. See above paragraph for possible explanation.

"I notice all your examples of professions having incremental pay rises are taken from public service. Care to mention any private industries that operate a similar system? No I thought not. " You are absoloutely right. But we are trying to compare apples and oranges. I could say - is there any other private industry that sends you on a 6 month course (day release, except the day is in your own time!), puts you through 3 written exams and a 4000 word paper, and when you get the qualification gives you a whole new level of responsibility (in this case non-medical prescribing) and gives you the financial reward of....zero. And there's the nub, the private sector recognises and rewards higher level performance that brings in additional income. Ours doesn't, so increments aren't a bad thing, they just need to be managed properly through the existing frameworks.

"And BTW yes I am a nurse for my sins." How about directing some of that negativity into positive action? What do we need to do to get us out of this fine mess?

Anon:
"There is a huge difference between causing "inconvenience" and putting people in danger. A responsibly organised strike could cause considerable inconvenience in many areas of nursing, without putting patients in danger. The problem is, the question of whether or not nurses will reach consensus on appropriate and effective industrial action." We have the potential to do so, it requires leadership, but, as Mark says, we may find out what this idea of leadersip is to amount to.

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